As we generally do with proposed regulations that impact EHR developers and their customers, the Electronic Health Record Association (EHRA) carefully reviewed and collectively commented on CMS’s proposed rule on the Hospital Outpatient Prospective Payment Systems (HOPPS) and EHR Incentive Program on September 1. Our comments, submitted on September 1 and available here, are based on the collective experiences of more than 30 EHRA member companies who service the vast majority of hospitals and ambulatory care providers using EHRs across the United States.

We put forth two key positions. The first centers around advocating for program alignment across Medicare and Medicaid requirements, as well as the EHR incentive programs with the Merit-Based Incentive Payment System (MIPS). The second states strongly that changes to the EHR incentive program at this late date relative to the current or next reporting period lead to costly and negative repercussions. We strongly recommend that CMS make every effort to incorporate the comments received up to and including this comment cycle in future rulemaking, in order to set appropriate and achievable requirements and deadlines to reduce the need for mid-year revisions.

These two important positions are referenced throughout the comments through examples such as the proposed 90-day reporting period in 2016 and the modifications to measure calculations to actions outside of the EHR reporting period.  With regard to the variety of changes to Medicare meaningful use criteria, the EHRA views each of these proposals through the lens of the effect such a change would have on program harmonization. We see the elimination of measures and adjustment of thresholds as a good, although incomplete, start toward what we hope will become a more complete conversion between the EHR Incentive Program and the Advancing Care Information (ACI) components of MIPS.  We leave most comments on individual measures to provider groups, with notable exceptions where clarifications are necessary, such as the Patient Access Measure.

In summarizing our comments, the EHRA recommends against updating measure thresholds each year, and offers a discussion of how to make measures more stringent in future years, as is required by the Social Security Act.  We believe that changes to the program should meet the goals of the Act, including improving patient care and effectively managing costs.  If the individual measures are more focused on that goal, and performance on such precise measures improves, then the bar for achievement rises and stringency is place in an effective and meaningful way.

We look forward to continuing our work with provider organizations, CMS, and other stakeholders in order to create programs that improve patient care and reduce unnecessary costs.  As always, the EHR Association and its members are committed to supporting safe healthcare delivery, fostering continued innovation, and operations with high integrity in the market for our users and their patients and families.